Abstract
Background Relapsed Ewing's sarcoma (RES) is an aggressive malignancy with poor survival. Although high-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) given after conventional chemotherapy (CC) has shown survival benefits, it is not generally used in the United States for RES. We performed a systemic review to evaluate the benefits of HDCT for RES. Methods Literature search involved Medline, Embase, and Cochrane database. We included studies with RES patients treated with HDCT/ASCT. Results Twenty-four studies with total of 345 reported RES patients that got HDCT were included in final analysis. Seventeen studies had patients with multiple malignancies including RES, while seven had only RES patients. At 2 and 3–5 years, event-free survival (EFS) in studies with only RES patients ranged 42–47% and 20–61% and overall survival (OS) ranged 50–66% and 33–77%, respectively. In studies with combined patients that reported outcomes of RES separately, the EFS at 1–3 and 4 years was 36–66% and 17–50%, respectively. The OS at 1-2 and 3-4 years was 40–60% and 50–70%. Conclusions Most studies using HDCT/ASCT as consolidation regimen showed improved survival benefits compared to CC. Randomized controlled studies are needed to determine true clinical benefits of HDCT followed by ASCT in patients with RES.
Highlights
Patients with localized primary Ewing’s sarcoma (ES) have 60–70% 5-year overall survival (OS) with multimodality treatment [1]
Conventional salvage chemotherapy (CC) regimens given at relapse have led to response rates up to 29–68.1% depending on the type of regimen used and site of relapse [6,7,8,9,10]. e event-free survival (EFS) at 10.3 months–2 years is noted to be 22.7–26% in the literature [8, 9]
Search Results. e systematic search identified a total of 1005 records. ese records were screened for relevance based on their titles and abstracts
Summary
Patients with localized primary Ewing’s sarcoma (ES) have 60–70% 5-year overall survival (OS) with multimodality treatment [1]. Despite its reported survival benefit, high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT) is not routinely. High-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) given after conventional chemotherapy (CC) has shown survival benefits, it is not generally used in the United States for RES. We included studies with RES patients treated with HDCT/ASCT. At 2 and 3–5 years, event-free survival (EFS) in studies with only RES patients ranged 42–47% and 20–61% and overall survival (OS) ranged 50–66% and 33–77%, respectively. In studies with combined patients that reported outcomes of RES separately, the EFS at 1–3 and 4 years was 36–66% and 17–50%, respectively.
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